Primary acute angle closure: long-term clinical outcomes over a 10-year period in the Chinese population

To investigate long-term clinical outcomes after acute angle closure in the Chinese population. A 10-year retrospective review of primary acute angle closure in Hong Kong Chinese to document patient demographics, treatment, and pre- and post-acute angle closure intraocular pressure (IOP) and visual acuity (VA). The year of attack was correlated with the timing of laser, last VA and IOP, and the number of anti-glaucoma eye drops. In 210 eyes (200 patients), 10 % had a simultaneous bilateral acute angle closure. VA improvement was noted in 68.6 % of eyes whilst 11.4 % were blinded. At 3.7 ± 2.4 years of follow-up, 49.5 % had IOP <21 mmHg with medication or surgery, 41.9 % needed anti-glaucoma eye drops, and 13.8 % had undergone trabeculectomy. The older the year of attack, the poorer the VA (r = 0.2, p = 0.03) and the longer the laser wait time (r = 0.3, p < 0.0001). VA outcome and laser promptness in acute angle closure has improved over the years. At 4 years after the attack, 50 % had normal IOP, 69 % had improved VA but 11 % were blinded.     

Sentinel lymph node biopsy for melanoma of the head and neck: a multicentre study to examine safety,efficacy, and prognostic value

Sentinel lymph node biopsy (SLNB) is an accurate staging procedure for malignant melanoma but its use in patients with melanoma of the head and neck has been questioned in the past because of a perceived record of poor safety and accuracy. Technical improvements have sought to redress this. Vital structures and variable lymphatic pathways can make its use in the head and neck challenging. In our study we have examined the data and the experiences of clinicians from University Hospital Southampton and the Royal Surrey County Hospital. We retrospectively analysed the data and case notes of 143 patients who had SLNB to establish its safety, efficacy, and prognostic value. The detection rate of at least one sentinel lymph node was 100%. Nodes positive for metastatic melanoma were found in 20% of patients. Of them, 76% went on to have completion lymphadenectomy. Multivariate Cox regression analysis suggested that positive SLNB was a strong predictor of reduced overall survival for all Breslow-thickness melanomas (HR = 3.9, p = 0.019) and intermediate melanomas (HR = 6.3, p = 0.007). It predicted reduced recurrence-free survival for all melanomas (HR = 7.4, p < 0.001) and was a strong predictor for those of intermediate thickness (HR = 8.3, p < 0.001). The false negative rate was 9.4% and false omission rate 2.6%. Temporary and permanent morbidity rates were 2.1% and 0%, respectively. SLNB for melanoma in the head and neck is a safe, accurate staging procedure that offers prognostically useful information. The upstaging of disease allows access to trial-based targeted treatments.